Defining "Value" In Cancer Care

by Stacey L. Worthy; Director of Public Policy, The Alliance for the Adoption of Innovations in Medicine (Aimed Alliance)

Looking at 2016 and beyond, there is a lot to celebrate about the nation’s progress in treating cancer. Breakthroughs are occurring at lightning speed, giving new hope and added years of life to those battling rare and hard-to-treat cancers, such as multiple myeloma and advanced lung cancer. Consider these major developments in 2015 alone:

» The Food and Drug Administration (FDA) approved 14 novel oncology drugs, including 10 immunotherapies that free up the body’s immune system to recognize and destroy specific cancer cells» The first genetically engineered virus reached the U.S. market to treat advanced melanoma, setting the stage for a long-awaited class of therapies» Former President Jimmy Carter announced that he was cancer-free after receiving an innovative therapy for a melanoma that had spread to his brain

Unfortunately, these scientific advancements were not the only significant developments in cancer care. Even as researchers and oncologists celebrated the rapid surge in the number of increasingly precise anticancer therapeutics, advocates were sounding the alarm over so-called “value frameworks” that may narrow treatment options for patients. Intended to assess the cost-effectiveness of new therapies, five such “value assessment tools” were either introduced or in development in 2015, mostly for newly approved oncology drugs. They are the American Society for Clinical Oncology’s “Value Framework,” the European Society for Medical Oncology’s “Magnitude of Clinical Benefit Scale,” the Institute for Clinical and Economic Review’s “Pricing Benchmark,” Memorial Sloan Kettering’s “DrugAbacus,” and the National Comprehensive Cancer Network’s “Evidence Blocks.”

An examination of these value tools finds each has a different design and uses different criteria. Yet, they all share a common element: “value” as it involves the cost-effectiveness of novel cancer drugs is determined based on the “average patient.” While this may be attractive to Medicare and some of the nation’s biggest health insurers due to a greater emphasis on cost, in reality, there is no average cancer patient – as the revolution in personalized medicine and immunotherapies clearly shows. Every person with cancer is unique, and even patients with the same type and stage of cancer may respond very differently to the exact same treatment regimen.

This truth is of central importance when defining the “value” of breakthrough treatments in terms of people’s lives. In economics, value is defined as “the measure of the benefit of a good or service,”—not the actual price. Therefore, health economists define the value of medicines as the health outcomes achieved – such as extra years of life, higher quality of life and fewer costly hospitalizations, invasive medical procedures, and doctor’s visits per dollar spent.

Applying this definition, innovative medicines provide increasing measurable value to patients, society, and the U.S. health care system, even as overall drug spending on a relative basis has remained constant for over 50 years. Using cancer as the case in point, new treatments have contributed to a 30 percent drop in cancer deaths over the last two decades, making it possible for patients to experience 50 million additional years of life and generate $4.7 trillion in economic activity. Based on these tangible measures, a 2009 study by Cornell University researchers concluded that when longevity, quality of life, and the greater efficacy of today’s treatments are considered, the true cost of cancer medications is 30 percent less than a decade ago.

Reinforcing these conclusions, the Commerce Department’s Bureau of Economic Analysis (BEA) applied 2015 data to report that “the net value of treatment has grown substantially, consistent with medical technology, leading to better health outcomes at a lower cost per patient.” Between 2000 and 2010, the report found an increase in positive health outcomes from treatment with new therapies in 20 of the 30 chronic diseases studied.

Based on this real-world evidence, the Alliance for the Adoption of Innovations in Medicine (Aimed Alliance) concurs with the views of cancer advocates that patients will be best served by definitions of “value” that put patients’ treatment needs ahead of dollars and cents. Otherwise, scientists will still get to celebrate the exciting breakthroughs in cancer drug discovery. However, restrictive value assessments are likely to keep many patients from gaining access to these medicines.